Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
UWORLD
Overall review 2
| Question | Answer |
|---|---|
| What is the main cause of pleural effusion due to heart failure (HF)? | Increase fluid inflow for the increase pulmonary capillary hydrostatic pressure |
| Which starling force in greatly increase in HF leading to development of pleural effusion? | Pulmonary capillary hydrostatic pressure |
| What is the response to pleural effusion in HF by the lymphatics in the lungs? | Lymphatic outflow increases but unable to keep up with the increased flow |
| What is another name for metanephros? | Metanephric blastema |
| Metanephric blastema gives rise to: ----> | Glomeruli, Bowman's space, proximal tubules, loop of Henle, and DCT |
| What embryological structure gives rise to the PCT and DCT? | Metanephric blastema |
| What are the derivatives of the Ureteric bud? | Collecting system, which includes the Collecting tubules, major and minor calyces, renal pelvis, and the ureters |
| What embryological structure gives rise the collecting tubules? | Ureteric bud |
| The calyces (major and minor) are derivatives the Metanephros or Ureteric bud? | Ureteric bud |
| The ureters are derivatives the Metanephros or Ureteric bud? | Ureteric bud |
| The Loop of Henle is a derivative the Metanephros or Ureteric bud? | Metanephros |
| The Bowman's space is a derivative of the Metanephros or Ureteric bud? | Metanephros |
| What is a common cause of Renal Artery Stenosis? | Fibromuscular dysplasia |
| How does Fibromuscular dysplasia cause RAS? | Abnormal tissue growth within arterial walls, resulting in STENOTIC and tortuous arteries that cause tissue ischemia and are prone to aneurysm formation |
| What are some pathological features often found in RAS due to fibromuscular dysplasia? | 1. Alternating fibromuscular webs 2. Aneurysmal dilation with absent internal elastic lamina |
| A biopsy shows an aneurysm dilation of a vessels with absent internal elastic lamina. What is the possible diagnosis? | RAS due to fibromuscular dysplasia |
| What is the overall description of a urine analysis of RAS? | Unremarkable |
| A person with sudden onset of HTN + unremarkable UA. Dx? | Renal Artery Stenosis |
| What is the rate limiting enzyme of Glycolysis? | PFK-1 |
| What is the most potent stimulator of PFK-1? | Fructose 2,6-bisphosphate |
| What metabolic process is mediated by rate of PFK-1 are rate limiting enzyme? | Glycolysis |
| What enzyme stimulates to increase production of F-2,6-bisphosphate by insulin? | PFK-2 |
| What is the relation between insulin and PFK-2? | Insulin increases F-2,6-bisphosphate production by using PFK-2, leading to stimulation of glycolysis |
| What are the second messenger type of receptors used by Calcium-sensing receptors? | GPCR |
| What is Familial Hypocalciuric hypercalcemia? | Bening AD disease caused by defective calcium sensing receptors in the PTH gland and kidneys |
| What is the defective receptor of Familial Hypocalciuric hypercalcemia? | Calccium-sensing receptors in PTH gland and kidneys |
| What is the Lac operon genetic structural definition? | Group of genes with a single promoter |
| What is the common use for the Lac operon? | Genes in the operon encode proteins that allow the bacteria to use lactose as an energy source |
| How is the Lac operon negatively regulated? | Negatively binding of the repressor upstream from the operator locus |
| How is the Lac operon positively regulated? | cAMP-CAP binding upstream from the promoter region |
| Which lac operon repressor protein is most likely affected by genetic mutation leading to constrictive expression of the lac operon? | Lac I |
| What is a common inhabitant of the oral cavity and cause of transient bacteremia after dental procedures? | Strep viridans |
| How is S. viridans able to cause endocarditis ? | Pre-existing valvular lesions, allow S. viridans to adhere to fibrin-platelet aggregates and establish the infection |
| What is the most characteristic clinical features of Sporotrichosis? | Papulomacular lesions distributed along the lymphatics |
| How is Sporotrichosis characterized histologically? | Granulomatous and neutrophilic inflammation |
| Is Sporotrichosis associated with lymphatic or neutrophils present in inflammation process? | Neutrophilic |
| What is Cryptococcus neoformans? | Yeast with a thick polysaccharide capsule that found primarily in soil contaminated by bird droppings |
| Does C. neoformans have a capsule or not? | Thick polysaccharide capsule |
| Common encapsulated yeast causative of meningitis in AIDS patients? | Cryptococcus neoformans |
| Which organ is first affected by C. neoformans infection and why? | Lungs; the pathogen ins fist inhaled and causes asymptomatic pulmonary infection |
| What is the consequence of a pulmonary C. neoformans infection in immunocompromised patient? | High risk of reactivation and spread to the CNS, leading to meningitis |
| What is a common (yeast) cause of meningitis in immunocompromised patients? | Cryptococcus neoformans |
| What is the common triad of symtps seen with Septic arthritis? | 1. Polyarthritis 2. Vesiculo-papular rash 3. Tenosynovitis |
| Common gram negative diplococci associated with development of Septic arthritis | N. gonorrhea |
| What is a common cause of Septic arthritis in a young, sexually active, and overall healthy person? | N. gonorrhea |
| Which feature of N. meningitidis allows for immunity with vaccine? | Antibodies against polysaccharide capsule |
| Which subtype of N. meningitis uses a recombinant protein type of vaccination? | Serotype B |
| What is Imiquimod? | Widely used topical immunomodulatory agent that stimulates a potent cellular and cytokine-based response to aberrant cells (HPV) by activating Toll-like receptors and upregulating NF-kB |
| What proteins and/or receptors are stimulated by Imiquimod? | Toll-like receptors and upregulate NF-kB |
| What are less common antiproliferative effects of Imiquimod? | Inhibition of angiogenesis and induction of apoptosis |
| Which is a common topical immunomodulatory agent, that is often used in HPV? | Imiquimod |
| How does a Permissive hormone work? | Has no effect on a physiologic process by itself but allow another hormone to exert its maximal effect on that process |
| What is a common permissive hormone used by catecholamines? | Cortisol |
| What would be the effect of cortisol alone on bronchodilation? | None |
| Why is cortisol often used along with Catecholamines in seeking quick bronchodilation? | Cortisol exerts a permissive hormone effect on catecholamines |
| What is the cortisol permissive effect on glucagon? | Increase glucose release from the liver |
| Which enzyme is used to convert nitrates to Nitric oxide? | Guanylate cyclase |
| Production of NO (nitric oxide) increases intracellular cAMP or cGMP? | cGMP |
| What is the result of increased cGMP intracellularly due to nitric oxide conversion? | Myosin-Light chain dephosphorylation resulting in vascular smooth muscle relaxation |
| Does Myosin-Light chain dephosphorylation or phosphorylation lead to vascular SM relaxation? | Myosin-Light chain dephosphorylation |
| If the vascular smooth muscle is contracting it is safe to assume --> | Myosin-Light chain phosphorylation |
| What is Diphenoxylate? | Opioid antidiarrheal drug that binds to mu-opiate receptors in the gut to slow motility |
| Does Diphenoxylate increase or decrease gut motility? | Decrease gut motility |
| What are common adverse effects of Diphenoxylate? | Euphoria and physical dependence |
| What drug is often used along with Diphenoxylate, in order to reduce risk of dependence? | Atropine, in order to enhance the adverse effects if taken in high doses |
| How do Protease inhibitors exert is antiviral effects? | Inhibition of the cleavage of polypeptide presucruse into mature viral proteins |
| Which antiviral drug category works by preventing the cleavage of immature viral protein into a mature protein, especially in HIV? | Protease inhibitors |
| What are the common effects of Protease inhibitors? | Hyperglycemia, lipodystrophy, and drug-drug interaction due to inhibition of CYP450 |
| Which HIV drug class has adverse effects such as hyperglycemia, lipodystrophy and inhibition of CYP450 system? | Protease inhibitors |
| What cardiac adrenergic receptors is most affected by Norepinephrine? | Cardiac B-1 |
| What does stimulation of cardiac B-1 receptor by NE causes? | Increase in cAMP conentaton within cardiomyocytes and leads to increased contractility, conduction, and heart rate |
| How does peripheral vasoconstriction occurs with Norepinephrine? | Stimulation of alpha-1 (a-1) receptors in vascular smooth muscle cells and activation of the IP3 signaling pathway |
| Which signaling pathway is activated by NE? | IP3 signaling pathway |
| What are the absolute contraindications for OCP therapy? | 1. Prior Hx of thromboembolic events or stroke 2. Hx of Estrogen-dependent tumor 3. Women over age of 35 who smoke heavily 4. Elevated serum triglycerides 5. Decompensated or active liver disease 6. Pregnancy |
| What is Empyema? | Accumulation of pus within the pleural space that can result from bacterial contamination |
| Infected pleural effusion, known as: | Empyema |
| What is indicated by the presence of Empyema, in regards of disease advancement? | Advance progression of a complicated parapneumonic effusion resulting from bacterial translocation from the alveoli. |
| What is the most common pathogen associated with cutaneous infection in burn patients? | Pseudomonas aeruginosa |
| What are common penicillins used to treat P. aeruginosa infection? | Ticarcillin and piperacillin |
| What are some cephalosporins used to treat Pseudomonas aeruginosa infection? | Ceftazidime and Cefepime |
| Besides penicillins and cephalosporins, what are some drugs that may treat Pseudomonas aeruginosa infection? | Aminoglycosides, Fluoroquinolones, and Carbapenems |
| What is Giardia? | Most common diarrheal parasite infection in the USA and Canada |
| What is the MCC of diarrhea in campers and hikers? | Giardia lamblia infection |
| How does a iodine-stain stool smear of Giardia appears under microscope inspection? | Pear-shaped flagellated trophozoites or Ellipsoidal cysts with smooth, well-defined walls and 2+ nuclei |
| What pathogen is described as "pear-shaped" flagellated trophozoites and 2+ nuclei under microscope inspection? | Giardia lamblia |
| What is the MC treatment option for Giardiasis? | Metronidazole |
| How does the diphtheria toxin works? | Irreversibly inhibits host protein synthesis due to ADP-ribosylation of elongation factor 2 |
| Which diarrhea causing organism works by inhibiting EF-2 due to ADP-ribosylation ? | Diphtheria infection |
| What infectious pathogen is associated with diarrhea and a pseudomembranous pharyngitis? | Diphtheria infection |
| What are the systemic effects of Diphtheria? | Life-threatening myocarditis and neuritis |
| What type of vaccine protects against Diphtheria? | Toxoid vaccine |
| How does Diphtheria vaccine works? | Generates proteictive circulating IgG against the exotoxin B subunit |
| What is a characteristic that any pathogen needs to overcome in order to cause stomach and/or small intestine disease? | Stomach acidity |
| Why does the chronic use of antacids lead to higher risk for stoach-associated illness? | It leads to decrease in gastric acidity, lower the minimum infectious dose of the pathogen by multiple orders of magnitude |
| What causes Chemotherapy-associated neutropenic fever? | Most often caused by endogenous commensal bacteria that have translocated across damaged mucosal sites |
| What is a common cause of Febrile Neutropenia? | Chemotherapy-associated Neutropenic Fever |
| What is another way to name the "5th Disease"? | Erythema infectiosum |
| What virus causes Erythema infectiosum? | Parvovirus B19 |
| How is Erythema infectiosum (5th disease) clinically presented? | - Nonspecific prodromal ( malaise, fever, congestion) - Followed by "slapped-cheek" facial rash and a lacy, reticular body rash |
| What condition features "slapped-cheek" facial rash as well as a lacy, reticular body rash? | Erythema infectiosum |
| Parvo B19 is highly trophic to which type of cells? | Erythroid precursor cells |
| What viral pathogen is highly trophic for erythroid precursor cells? | Parvovirus B19 |
| Where to most of Parvovirus B19 replication? | Bone marrow |
| What are the precautions needed to attend a C. difficile infected patient? | Hand washing with soap and water, gown, and non-sterile gloves |
| Do alcohol based hand sanitizers kill spores? | No; spores are not killed with alcohol-based hand sanitizers |
| What is a common medication widely used for treating Malignant Hypertension? | Labetalol |
| What condition is often treated with Labetalol? | Malignant Hypertension |
| What is the MOA of Labetalol? | Non-selective B-blocker that block B1, B2, and A-1 |
| What is the result of A-1 > B-2 blockade by Labetalol? | Peripheral vasodilation with decreased venous return and decreased SVR |
| What does the B-1 receptor blockage benefit in Labetalol mode of action? | It overrides the expected baroreflex-mediated tachycardia, resulting in overall decrease in heart rate |
| Which medication is known to block B-1 receptor, leading to prevention of Baroreflex-mediated tachycardia? | Labetalol |
| What is the definition of half life? | Measure of how quickly a drug with 1st order kinetics is eliminated from the body |
| How many half-lives are needed to almost completely eliminated? | 5 half-lives intervals |
| (0.7) Volume of distribution (Vd) / Clearance rate (CL) = | Half-life |
| What is the constant used to calculate half-life? | 0.7 |
| What is the result to half-life in cases of increased Vd or decrease CL? | Increase of half-life |
| What is Monoamine oxidase (MAO)? | Mitochondrial enzyme that breaks down MAO neurotransmitters |
| What neurotransmitters are broken down by MAO? | Dopamine, Serotonin, and Norepinephrine |
| When does a Tyramine-induced hypertensive crisis occur? | In patient taking MAO inhibitors that consume foods with high content of tyramine |
| What is a severe consequence of a person indulging in high content tyramine foods such as cheese and wine, and also treating refractive depression with Selegiline? | Tyramine-induced hypertensive crisis |
| Why is Epinephrine often added to Lidocaine? | In order to produce vasoconstriction, prolonging Lidocaine duration of action, decrease possibility of bleeding during procedure,a nd reduces systemic lidocaine absorptin |
| What can be co-administered with Lidocaine in order to decrease changes of bleeding during surgery and as well prolonging the action of Lidocaine? | Epinephrine |
| What hormonal condition is associated with Graves Ophthalmopathy? | Hyperthyroidism |
| What are causes Graves Ophthalmopathy? | Orbital fibroblasts by thyrotropin receptor antibodies and cytokines released by activated T-cells |
| What is the best treatment for Graves Ophthalmopathy? | Corticosteroids |
| Why are corticosteroids used to treat Graves Ophthalmopathy? | Decrease inflammation and reduce the excess extraocular volume |
| What are TIAs? | Transient episodes of focal neurologic impairment that occur due to local brain ischemia |
| Is there brain (tissue) infarction in TIA? | No tissue infarction (death) and brain imaging is normal |
| What are some secondary measures to prevent TIA? | 1. Antiplatelet agents (aspirin, clopidogrel) 2. Statins 3. Lifestyle modifications |
| What electrolyte and other levels are increased in serum concentration in Tumor Lysis syndrome? | Hyperphosphatemia, Hyperkalemia, and Hyperuricemia |
| Tumor Lysis syndrome presented with the following serum levels: | 1. Hyperphosphatemia, hyperkalemia, and Hyperuricemia 2. Hypocalcemia |
| Is TLS associated with hypo- or hypercalcemia? | Hypocalcemia |
| What are common agents used to prevent development of TLS? | 1. Hyperuricemic agents (Rasburicase, allopurinol adn Febuxostat) |
| What is the mode of action of Rasburicase? | Works by converting of uric acid into a more soluble metabolite (allantoin) |
| What medication can be said to be a form of Urate oxidase? | Rasburicase |
| What medication is known to convert Uric acid into Allantoin? | Rasburicase |
| Which is more soluble in water, uric acid or allantoin? | Allantoin |
| What are some common cardiovascular adrenergic agonists? | Dobutamine Dopamine Epinephrine Isoproterenol Norepinephrine Phenylephrine |
| What are the effects on SVR, BP and peripheral vascular resistance of NE? | Stimulation of alpha-1 receptors cause peripheral vascular constriction, increase in SVR and BP |
| Does direct B-1 adrenergic receptor stimulation cause increase in HR or decrease in HR? | Increase in heart rate, which is quickly undermined by the Baroreceptor-mediated reflex |
| Why is there an overall decrease in HR in NE, and not the expected increase? | Due to the Baroreceptor-mediated reflex |
| What is the order of affinity of NE to alpha-1, beta-1, and beta-2 adrenergic receptors? | A-1 > B-1 > B-2 |
| What dose of Epinephrine leads to same order to affinity to a-1, b-1,and b-2 as Norepinephrine? | High dose of Epinephrine leads to a1> b1 >b2 affinity |
| What is the initial treatment for DKA? | IV regular insulin |
| What is the purpose of treating DKA with regular insulin? | Rapid adjusted in blood glucose levels |
| What is the peak time of activity and effect of regular insulin? | 2-4 hours |
| How long would the effects of regular insulin (if given subcutaneously) last? | 5-7 hours |
| How long does a patient with DKA, and treated with subcutaneous regular insulin need to wait in order for drug to start working? | 30 minutes |
| Why is DKA treated with IV insulin rather than subcutaneous regular insulin? | IV regular insulin infusion works immediately after administration, while subcutaneous administration requires of 30 minutes |
| Where is the AV node located? | Endocardial surface of the right atrium, near the insertion of the septal leaflet of the tricuspid valve and the orifice of the coronary sinus |
| Is the AV node located in the Right or Left atrium? | Right atrium |
| What is the distribution of the reactivation of herpes zoster? | Single or multiple-adjacent dorsal spinal ganglia, leading to vesicular rash in a dermatomal distribution |
| Where part of the ganglia is involved n reactivation of Herpes zoster? | Dorsal spinal ganglia |
| Which dermatome supply the anteromedial thigh and medial leg? | L3 and L4 |
| What part of the body is covered by L3 and L4? | Anteromedial thigh and medial leg |
| What type of nerve block is used for surgery for shoulder and upper arm surgery? | Interscalene nerve block |
| At what nerve level is the Interscalene nerve block applied? | C5-C7 |
| Where is the interscalene nerve block applied? | Upper brachial plexus, as ti passes the anterior and middle Scalene muscles |
| What is a consequence of Interscalene muscle other than anesthetic desired effects? | Transient ipsilateral diaphragmatic paralysis due to involvement of the phrenic nerve |
| What nerve is injured or affected in resulting ipsilateral diaphragmatic paralysis? | Phrenic nerve |
| What are the nerve roots of the Phrenic nerve? | C3-C5 |
| What is Genomic Imprinting? | Phenomenon in which of an offspring's genes are expressed in a parent-specific manner |
| What causes genomic imprinting? | DNA methylation |
| What genetic process is associated with DNA methylation? | Genomic imprinting |
| Genomic imprint interferes or is involved in transcription or translation? | Transcription |
| What is DNA methylation? | Epigenetic process in which a gene can be silenced by attaching methyl groups to cytosine residues in the DNA molecule |
| What are the histological findings following a MI after 1-3 days from initial onst? | Neutrophils infiltrate the border zone of the injured tissue |
| After 48 hours from an MI, which cells (WBC) appear on seen at the border regions of the ischemic tissue? | Neutrophils |
| What leads to the appearance of neutrophil infiltrate 1-3 days after inMI? | In response to pro-inflammatory cytokines |
| What are two common proinflammatory cytokines involved in Neutrophil infiltration after a myocardial infarction? | IL-6 and IL-8 |
| What type of hypersensitivity reaction is Contact dermatitis? | Type IV |
| What is the initial event in pathogenesis of Contact dermatitis? | Langerhan cells travel to regional lymph nodes and present haptens to naive T-cells, leading to clonal expansion |
| On re-exposure with a hapten, what occurs in regards to cell actions? | Sensitized T cells cause tissue destruction that manifests as Pruritic erythema, vesicles, and/or bullae 2-3 days after the exposure |
| Does contact dermatitis preocupe a rash upon first time exposure the hapten? | No |
| What is an example of a Flavivirus? | Zika virus |
| What is the genetic composition of the Zika virus? | Single-stranded RNA virus |
| What cells are attacked or affected by the Zika virus? | Fetal neural progenitor cells |
| What are the congenital abnormalities are seen with Zika virus infection? | - Congenital malformations (microcephaly, athro spondylitis), - Cerebral cortical thinning, - Fetal death |
| What are the brain imaging findings of a patient with Zika virus? | Calcifications, ventriculomegaly, cortical thinning |
| What is the second MCC of Neonatal meningitis? | E. coli |
| What is the main pathogen causative of Neonatal meningitis? | Group B streptococci |
| What virulence factor of E. coli is involved in causing neonatal meningitis? | K1 capsule |
| What is the K1 capsule? | Virulence factor that allows the bacteria (E.coli) to survive in the bloodstream and establish meningeal infection |
| What symptoms are often seen in patient with Renal cell carcinoma? | Hematuria, abdominal mass, or flank pain |
| What is the histopathological description of findings in RCC? | Rounded, polygonal cells with clear cytoplasm |
| What are some risk factors for Renal Cell carcinoma? | Smoking, toxin exposure, and hereditary disorders such as von-Hippel Lindau syndrome |
| What does the urine sediment in urolithiasis indicate? | Free RBCs (hematuria) and crystals consistent with the type of stone |
| What are the ultrasound findings of Renal calculi? | Ureteral and calyceal dilation (hydronephrosis), although the stones are not visible |
| What disease is due to parvovirus B19? | Erythema infectiosum |
| What is another name of Erythema infectiosum? | Fifth disease |
| What is the result of Parvo B19 infection in adults? | Arthritis |
| What can be a differential diagnosis to parvo B19 infection in an adult? | Rheumatoid arthritis |
| What characterizes Burkitt lymphoma? | Aggressive rapid growth and a "starry sky" microscopic appearance |
| Which oncogene is involved with Burkitt lymphoma? | c-MYC oncogene |
| Where is the translocation of Burkitt lymphoma? | In the c-MYC oncogene on the long arm of chromosome 8 with the Ig heavy chain region on chromosome 14 |
| What malignancy is associated with t(8;14)? | Burkitt lymphoma |
| What is "MYC"? | Nuclear phosphoprotein that functions as a Transcriptional activator |
| Which enzyme is blocked by the use of Warfarin? | Epoxide reductase |
| What is the result of blocking Epoxide reductase with Warfarin? | Lowering the formation of vitamin K i the liver, overall leading to a decrease in clotting factors |
| What are the vitamin-K dependent clotting factors? | 2, 7, 9, 10 |
| How long is the therapeutic effect of Warfarin takes effect? | 3-5 days |
| Why does Warfarin effect take nearly 3-5 days? | It takes effect until preexisting clotting factors are consumed |
| What is the Jarisch-Herxheimer reaction? | Acute inflammatory reaction that occurs within hours of treatment of spirochetal infections |
| What infection is often associated with Jarisch-Herxheimer reaction? | Syphilis |
Created by:
rakomi
Popular USMLE sets